Impact on the brain of the inflammatory response to surgery.
Impact on the brain of the inflammatory response to surgery.
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DOI：
10.1016/j.lpm.2018.03.011
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发表时间：
2018-04
期刊：
影响因子：
--
通讯作者：
Maze M
中科院分区：
文献类型：
--
作者：
Saxena S;Maze M
大脑既是先天免疫系统对手术无菌创伤做出反应的协调者，也是目标。当创伤引起的炎症没有得到适当的调控时，持续性的神经炎症会干扰作为认知学习和记忆方面基础的突触可塑性。随之而来的并发症包括术后妄想(POD)和术后认知功能障碍(POCD)，这一星座的两极现在被称为围手术期神经认知障碍。虽然急性POD与更懒惰的POCD的关系还不完全清楚，但两者都可能因更早发病的痴呆症和更高的死亡率而进一步复杂化。这些疾病是如何以及为什么发生的是本报告的重点。与生俱来的免疫系统对外周创伤的反应通过一系列受调控的细胞和分子行为因子向大脑发出信号，产生一种目的性防御机制--“疾病行为”，以减少进一步的损伤并启动修复。疾病行为，包括认知障碍，由神经和体液途径终止，这些途径恢复体内平衡，使机体走上健康之路。由于有如此多的“活动部件”，先天性免疫系统在临床环境中是脆弱的，包括高龄和生活方式引起的疾病，如“不健康的”肥胖和不可避免的胰岛素抵抗。在这种情况下，炎症可能会变得夸张和持久。提供了如何识别高危外科患者以及药理学(包括生物化合物)和非药理学策略以定制护理的考虑。
The brain is both the orchestrator as well as the target of the innate immune system’s response to the aseptic trauma of surgery. When trauma-induced inflammation is not appropriately regulated persistent neuro-inflammation interferes with the synaptic plasticity that underlies the learning and memory aspects of cognition. The complications that ensue, include Postoperative Delirium (POD) and Postoperative Cognitive Dysfunction (POCD) at two poles of a constellation that is now termed Perioperative Neurocognitive Disorders. While the relationship of acute POD to the more indolent POCD is not completely understood both can be further complicated by earlier-onset of dementia and higher mortality. How and why these disorders occur is the focus of this report. The innate immune system response to peripheral trauma signals to the brain through a regulated cascade of cellular and molecular actors producing a teleological defense mechanism, “sickness behavior,” to curtail further injury and initiate repair. Sickness behavior, including disordered cognition, is terminated by neural and humoral pathways that restore homeostasis and launch the organism on a path to good health. With so many “moving parts” the innate immune system is vulnerable in clinical settings that include advanced age and lifestyle-induced diseases such as “unhealthy” obesity and the inevitable insulin resistance. Under these conditions inflammation may become exaggerated and long-lived. Consideration is provided how to identify the high-risk surgical patient and both pharmacological (including biological compounds) and non- pharmacological strategies to customize care.
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影响因子：
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影响因子：
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